Why more doctors are choosing direct care over traditional health care

Physician
July 10, 2025

Let’s start with a simple truth: Medicine is hard.

It’s hard for doctors, and it’s hard for patients. The headaches of today’s health care ecosystem—endless paperwork, shrinking appointment times, and the ever-present shadow of insurance approvals—can make it feel like the heart of medicine is slipping away.

Lost in the system

For years, I practiced in the traditional insurance-based model. I loved being a doctor, but I found myself spending more time on …

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Why hospitals are quietly capping top doctors’ pay

Conditions
July 10, 2025

Are 10 percent (or 25 percent) of all the physicians in your specialty breaking the law?

Of course not! Who would think such a thing?

Your friendly neighborhood “nonprofit” hospital, that’s who!

I have been reviewing physician employment agreements for almost 40 years, and in the last few years I have noticed a spike in the number of agreements that “cap” physician salary. A shocking number of hospital employment agreements provide that the …

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Why point-of-care ultrasound belongs in emergency department triage

Conditions
July 10, 2025

The ED is swamped with new patient arrivals. As a result, the 20-year-old who told the triage nurse he is having difficulty breathing waits an hour before his turn in the triage room. The emergency department technician hands me the ECG—sinus tachycardia—and takes the vitals.

Me: “What brings you to the emergency department today?”

Him: “I feel like I cannot breathe. It started all of a sudden at work.”

As I scroll through …

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Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

Podcast
July 9, 2025
YouTube video

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Emergency physicians Resa E. Lewiss and Courtney M. Smalley discuss their article, “Why point-of-care ultrasound belongs in emergency department triage.” Amid the crisis of overcrowded waiting rooms and long wait times, they …

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Why PSA levels alone shouldn’t define your prostate cancer risk

Conditions
July 9, 2025

“My PSA came back at 6.2 — does that mean I have cancer?”

It’s one of the most common and emotionally charged questions I hear in the clinic. The prostate-specific antigen (PSA) test, once celebrated as a breakthrough in early cancer detection, has become a double-edged sword. For many men, a slightly elevated PSA level is enough to trigger panic — and for some physicians, enough to trigger a biopsy.

But here’s …

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How to handle chronically late patients in your medical practice

Physician
July 9, 2025

An excerpt from Medicine is a Practice: The Rules for Healthcare Marketing.

“I’m late! I’m late! For a very important date!”
— The White Rabbit, Alice’s Adventures in Wonderland, Lewis Carroll

Lewis Carroll wrote about the tardiness of the White Rabbit in Alice’s Adventures in Wonderland in 1865. The problem of tardiness is older than the White Rabbit, and lack of punctuality plagues every profession and human interaction. Unfortunately, in the medical …

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Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

Conditions
July 9, 2025

Canada is one of the few countries permitting Medical Assistance in Dying (MAiD) for individuals with non-terminal chronic pain. While this respects individual autonomy, it also introduces a duty of care: We must ensure that death is not chosen because of inadequate care. Some Canadian advocacy groups, like the British Columbia Civil Liberties Association (BCCLA), have expressed deep concerns over how MAiD is being expanded in Canada.

The BCCLA initially …

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How early meetings and after-hours events penalize physician-mothers

Physician
July 9, 2025

Medicine has long valorized the early riser – the physician who arrives before sunrise, who joins 7:30 a.m. meetings and stays for evening journal clubs, case conferences, and post-dinner networking events. These scheduling patterns have come to symbolize dedication, productivity, and professionalism. However, for many physicians, particularly those with caregiving responsibilities, these norms reflect more than tradition; they represent structural exclusion.

The architecture of medical professionalism was built on an outdated …

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Why medicine must evolve to support modern physicians

Physician
July 9, 2025

Physicians are human. Medicine is a career—not a lifelong vow of self-sacrifice.

Yes, for some, it may feel like a calling. But let’s be clear: Choosing medicine doesn’t mean surrendering your identity forever. Times have changed. Our mindset must, too.

Working part-time, seeking balance, or transitioning into leadership, education, or non-clinical roles is not a betrayal of the profession. It’s growth. Yet these choices are too often dismissed as abandonment.

We must let …

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Why listening to parents’ intuition can save lives in pediatric care

Physician
July 9, 2025

“The value of intuition in clinical practice” prompted me to reflect on one of the deeper regrets I carry from my clinical practice—those moments when I didn’t fully acknowledge or act upon a parent’s intuition, often a mother’s, that something was wrong with their child.

As clinicians, we are trained to listen for clinical “buzz words”—specific complaints or symptom patterns that guide our diagnostic reasoning. These cues form the backbone …

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Why financial planning is a critical tool for physician well-being [PODCAST]

Podcast
July 8, 2025
YouTube video

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Certified financial planner Brian Case discusses the article, “Personal financial planning shouldn’t be a taboo subject.” They explore the often-overlooked link between financial stress and the crisis of physician burnout, turnover, and …

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America’s ER crisis: Why the system is collapsing from within

Conditions
July 8, 2025

The Pitt was compelling TV.

As an emergency nurse educator for a Stanford campus in Northern California, there is one thing that is required viewing for my new graduate nurses: The Pitt.

The ambitious series did an admirable job portraying the complex world of the emergency department. The procedures were clinically accurate. The spectrum of patients and social issues was nuanced and believable. They even showcased the incidence of post-COVID PTSD, an …

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Why timing, not surgery, determines patient survival

Conditions
July 8, 2025

She was 68. Diabetic. Living alone with chronic osteoarthritis. Like many patients, she carried a story more complex than any preoperative checklist could capture: a long history of opioid dependence, obesity, limited mobility, and no one at home to help her recover.

Her total knee replacement—performed with state-of-the-art robotic precision—was flawless. The surgical plan was executed to perfection. The implant was perfectly aligned. She was discharged on time, per protocol.

But protocol …

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How medicine repurposing enables value-based pain management and insomnia therapy

Meds
July 8, 2025

In today’s evolving health care environment, value-based care is reshaping the future of medicine. The push toward value-based care demands innovative, cost-effective, and patient-centered solutions. A promising yet underutilized strategy is medicine repurposing, the practice of using existing medicines for new therapeutic purposes. Drug repurposing provides a strategic pathway to improving health outcomes while minimizing costs. A compelling example of this approach is the use of clonidine, a long-established cardiovascular …

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Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

Physician
July 8, 2025

The modern medical profession presents practitioners with an abundance of opportunities that extend far beyond traditional patient care. Today’s physicians navigate complex roles as clinicians, researchers, educators, administrators, and community leaders while maintaining personal relationships and spiritual well-being. Rather than viewing these diverse responsibilities as competing demands, successful physicians learn to integrate them into a balanced approach that prioritizes meaningful contribution over external recognition.

The myth of perfect balance

The concept of …

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Forced voicemail and diagnosis codes are endangering patient access to medications

Meds
July 8, 2025

I won’t be using CVS pharmacies anymore. Sure, I may still need to send prescriptions their way as a physician—but as a consumer, I’m done.

Why?

CVS has recently implemented a new phone system that forces callers to leave a voicemail instead of waiting on hold. The idea is to streamline operations, letting pharmacy staff return calls when they have time. It’s supposed to manage call volume, reduce wait times, and shield …

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How regulatory overreach is destroying innovation in U.S. health care

Physician
July 8, 2025

Health care regulatory bodies have embraced a dangerous “accuse first, prove later” strategy that is eroding the foundation of our health care system. Physicians, the bedrock of patient care, are being subjected to accusations based on flimsy, illegitimate reports or random audits. Rather than building cases on substantial initial evidence, these authorities thrive on retrospective scrutiny—analyzing old notes, reframing past actions, and bending interpretations of guidelines to validate their accusations. …

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Why the U.S. mental health care system is failing and how to fix it [PODCAST]

Podcast
July 7, 2025
YouTube video

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Internal medicine physician and author Robert C. Smith discusses his article, “Medicine’s mental health crisis: why the system is failing us.” He reveals the shocking disparity in care, where only 25 percent of patients with mental illness receive any treatment compared to 70 percent for …

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The unseen cost of detachment in radiology

Physician
July 7, 2025

That was one of my uneventful night duties—until early morning. As usual, I had a hectic on-call day, where I barely got half an hour for dinner—which we consider routine. Around 3 a.m., I received a request for an abdominal CT scan for a middle-aged male patient with abdominal pain. The surgeons were suspecting mesenteric ischemia—blockage in abdominal vessels, which can be life-threatening.

I glanced through the scan, trying to open …

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I thought success was a destination. Then I became a doctor.

Physician
July 7, 2025

When I began the journey to becoming a doctor, I believed success was a destination—a finish line I’d reach if I just worked hard enough, studied long enough, and sacrificed deeply enough.

And I did all those things.

I pushed through sleepless nights in college. Carried the weight of relentless pressure in medical school. Survived the grind of residency, where time lost all meaning. I lived with my eyes fixed on the …

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